Prevalence and clinical implications of heterotopic ossification after distal biceps tendon repair


elbow, biceps, complication, imaging, sports

Published online: Jan 09 2024


1 AZ Monica Hospital, Department of Orthopaedic surgery and Traumatology, Deurne, Belgium
2 UZ Leuven, Department of Orthopaedic Surgery and Traumatology, Leuven, Belgium
3 Ziekenhuis Oost-Limburg, Department of Orthopaedics surgery and Traumatology, Genk, Belgium
4 University of Antwerp, Department of Orthopedic surgery and Traumatology, Edegem, Belgium
5 Harley Street Specialist Hospital, London, UK


Complete distal biceps tendon ruptures are relatively uncommon. Conservative treatment may result in persistent pain and weakness. Therefore, surgical repair is usually indicated in order to restore strength. Different surgical techniques and fixation methods have been described. The most reported complications after surgery are iatrogenic nerve damage, heterotopic ossification (HO) and re-rupture. Heterotopic ossification can be variable in size. Significant HO can limit range of motion while minor HO often remains asymptomatic. The overall presence of HO is likely underreported in literature, as imaging is reserved for symptomatic patients. The purpose of this study is to report the prevalence and clinical implications of heterotopic ossification after surgical repair of the distal biceps tendon. This retrospective study assessed the prevalence and clinical relevance of postoperative HO after distal biceps tendon repair. CT-scans were used to evaluate size and location of the HO. VAS scores, DASH scores, MEPI, and range of motion (ROM) were assessed to evaluate pain, patient satisfaction and elbow function. HO was observed on CT images of 19 out of 35 patients (54%). The use of interference screws, timing of surgery after rupture and timing of radiographic assessment postoperatively did not influence the prevalence of HO. The presence of HO had no statistically significant impact on the VAS scores, ROM measurements and MEPI and DASH scores. According to our findings, the overall incidence of HO is higher than previously reported but there are no differences in clinical outcomes when compared to patients without HO.